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Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach
  1. H T M van Schie (j.vanschie{at}erasmusmc.nl)
  1. Erasmus University Medical Centre, Dept. of Orthopaedics & Dept. of Equine Sciences, Utrecht, Netherlands
    1. R J de Vos (rj_devos{at}hotmail.com)
    1. Erasmus University Medical Centre, Dept. of Orthopaedics & The Hague Medical Centre Antoniushove, Netherlands
      1. S de Jonge (s.de.jonge{at}umail.leidenuniv.nl)
      1. The Hague Medical Centre Antoniushove, Leidschendam, Netherlands
        1. E M Bakker (embakker{at}xs4all.nl)
        1. Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
          1. M P Heijboer (m.heijboer{at}erasmusmc.nl)
          1. Erasmus University Medical Centre, Dept. of Orthopaedics, Rotterdam, Netherlands
            1. J A N Verhaar (j.verhaar{at}erasmusmc.nl)
            1. Erasmus University Medical Centre, Dept. of Orthopaedics, Rotterdam, Netherlands
              1. J L Tol (h.tol{at}mchaaglanden.nl)
              1. The Hague Medical Centre Antoniushove, Leidschendam, Netherlands
                1. H Weinans (h.weinans{at}erasmusmc.nl)
                1. Erasmus University Medical Centre, Dept. of Orthopaedics, Rotterdam, Netherlands

                  Abstract

                  Objective: To asses if three-dimensional imaging of the Achilles tendon by Ultrasonographic Tissue Characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons.

                  Design: Case-control study.

                  Setting: Sports medical department of The Hague medical centre.

                  Patients: Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The “matched” control group consisted of 26 asymptomatic tendons.

                  Interventions: Symptomatic and asymptomatic tendons were scanned using the UTC-procedure. One researcher performed the ultrasonographic data-collection. These blinded data were randomised and outcome measures were determined by two independent observers.

                  Main outcome measurements: The raw ultrasonographic images were analysed with a custom-designed algorithm that quantifies the three-dimensional stability of echopatterns, qua intensity and distribution over contiguous transverse images. This three-dimensional stability was related to tendon structure in previous studies. UTC categorizes four different echo-types that represent: I) highly stable; II) medium stable; III) highly variable and IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated and the maximum tendon-thickness was measured. Finally, the inter-observer reliability of UTC was determined.

                  Results: Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% versus 76.6%, p<0.001), thus less three-dimensional stability of the echopattern. The mean maximum tendon thickness was 9.2 mm in the symptomatic group and 6.8 mm in the asymptomatic group (p<0.001). The Intra-class Correlation Coefficient (ICC) for the inter-observer reliability of determining the echo-types I+II was 0.95. The ICC for tendon thickness was 0.84.

                  Conclusion: UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such UTC might be useful to monitor treatment protocols.

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